You are not Alone...
Mental Health/Mental Illness Decade of the Brain

PREFACE

If you have a mental illness, you are not alone. One in five
adult
Americans will have a mental illness during their lifetime that
is
severe enough to require treatment. Many more have problems that
prevent them from enjoying their lives.

Fortunately, effective treatments are now available for many
mental
illnesses. Unfortunately, most people do not seek help. Many
wrongly
believe their symptoms are their own fault or are caused by
personal
weakness. They think if they try hard enough they can overcome
their
problems by themselves, and they suffer unnecessarily.

In actuality, mental illnesses often involve biological
dysfunctions
that require professional treatment. An individual with a mental
illness needs treatment and help in coping with everyday
problems. In
contrast, individuals who do not have a mental illness can
usually
deal with ordinary problems by themselves. At times of
particular
stress, however, even mentally healthy persons will find
professional
assistance useful.
The following discussion of mental health and mental illnesses is
designed to provide information that can help people lead
happier,
healthier lives.

WHAT IS MENTAL HEALTH?

While mental health can mean many things to many people,
self-esteem
and the capacity to care about others are universally important
components of mental health. Mentally healthy people understand
that
they are not perfect nor can they be all things to all people.
They
experience a full range of emotions including sadness, anger, and
frustration as well as joy, love, and satisfaction. While they
typically can handle life's challenges and changes, they can
reach out
for help if they are having difficulty dealing with major traumas
and
transitions--loss of loved ones, marriage difficulties, school or
work
problems, the prospect of retirement.

HELPING YOURSELF--AND OTHERS--TO MENTAL HEALTH

There are a number of steps you can take to help maintain good
mental
health. When you reduce your own stress level, you put others at
ease
too. When you are cooperative and outgoing, you bring out the
cooperative spirit in others. Here are some suggestions:

Take a realistic approach. If there's a job to do, get
it done
without ruffling the feathers of other people. Accept a
challenge.
Take command of the situation. Set goals. Keep them in
perspective
and see them as part of a larger purpose. Compromise with others
who
may not see eye-to-eye with you on every point. Remember, they
also
have rights. Enlist cooperation rather than arouse antagonism.
Suggest a family or staff meeting to encourage cooperation and
compromise.

Learn to recognize and express your feelings. Try not to
label
feelings--yours or others--as "good" or "bad." It is human to
experience a wide range of feelings. It is generally healthy to
express feelings as soon as possible in a suitable way since,
when
pent up, they can result in inappropriate responses. For
example, if
you feel put down or ignored and suppress your feelings, you may
later
vent your anger on someone else or you may turn it inward and
feel
depressed. Know why you feel angry and express your feelings as
calmly as possible. Or talk matters over with a sensible,
trustworthy
person--a wise friend, a clergyman, a physician, a relative, or a
professional counselor. This approach may help you to think more
clearly, handle your feelings appropriately, and better
understand the
feelings of others as well.

Don't brood. Often a simple change of pace or a
refocusing of
energies is a constructive way of "getting away from it all."
Instead
of brooding, do something--no matter how small--positive and
useful
about a problem. Try not to worry about the things you cannot
change.

Proceed one step at a time. To escape the feeling that
you're
trapped, evaluate your problem, consider each step necessary to
solve
it, and work toward a solution. This "one-step-at-a-time"
approach
will allow you to take pride in your ability to handle the
situation.
By diverting your tensions and anger to worthwhile and reachable
goals, you will be amazed by how much control you can exert in
managing your life.

WHAT TO WATCH FOR

Even when you try your best, you will still experience periods of
frustration and unhappiness. Usually, with time, you will
overcome
your distress. But you should learn to recognize when your
problems--or those of your loved ones--are too much to handle
alone.

You can help yourself, your family, and your friends by knowing
when
to ask for professional help. Some of the warning signs include:

Undue prolonged anxiety. This is an anxiety out of
proportion to any
identifiable reason or cause. Of course, everyone experiences
problems that make them tense and anxious. But a deep,
continuing
anxiety--a state of almost constant tension and fear that may
fasten
itself to one cause after another--is a signal that help is
needed.
Unrelieved anxiety not only causes mental anguish but also can
lead to
physical problems.

Prolonged or severe depression. Clinical
depression--which is quite
different from normal depressed feelings or "the blues"--
strongly
affects thinking, feelings, and behavior. Persistent feelings of
inadequacy, sadness, helplessness, hopelessness, undue pessimism,
and
loss of confidence are some of the symptoms of depression.
Changes in
behavior patterns are a key sign that depression may be getting
out of
hand and help should be sought.

Depressed individuals often withdraw from friends they normally
enjoy,
from loved ones, and from the usual occupation and hobbies that
give
pleasure. Their eating and sleeping habits change. Some suffer
from
loss of appetite and insomnia, especially an inability to stay
asleep;
others seek solace in overeating and excess sleeping.

Other symptoms of depression include low energy, chronic fatigue,
decreased effectiveness at school, work, or home, and loss of
sexual
interest. Depressed individuals are those most likely to think
of
suicide as a solution, although people with other mental and
emotional
disturbances may also be suicidal. During periods of crisis,
people
should be with others, avoiding isolation.

Abrupt changes in mood and behavior. These changes do
not include
deliberate steps a person adopts for self-improvement. They
refer to
changes in mood and behavior that reflect serious alterations in
an
individual's normal habits or way of thinking. For example, the
good
student whose grades abruptly drop or the frugal man or woman who
suddenly begins gambling away large sums of money is very likely
to be
experiencing emotional problems. Also, frequent or regular mood
changes from highs to lows, whether gradual or abrupt, can signal
a
mood disorder.

Physical symptoms that may be related to tension.
Some bodily
ailments and complaints--headaches (including migraines), nausea,
or
unexplained pains--may have no identifiable physical cause.
These
symptoms, including pain, are very real. But only a physician is
qualified to determine whether they are caused by medical
illness.
Because medical tests may reveal an organic cause, any persistent
physical ailment should be checked by a doctor.

If any of the warning signs described above are severe or long
lasting, whether caused by a medical illness or not, professional
help
may be needed.

"KINDS" OF MENTAL ILLNESS*

Schizophrenic disorders. In any given year,
approximately 1.8 million
people in this country, or 1 percent of the population, are
affected
by a form of schizophrenia.** This complex and extremely
puzzling
type of mental illness is particularly disabling, generally
interfering with the ability to work, relate to others, and take
care
of oneself.

Generally, symptoms of schizophrenia become apparent during
adolescence or early adulthood, but can begin later in life.
Symptoms
may include delusions (false beliefs, sometimes paranoid in
nature,
whereby the individual wrongly feels persecuted or endangered),
hallucinations (hearing voices that are not present),
disconnected or
incoherent speech, withdrawal from the outside world, grossly
inappropriate feelings, or abnormal psychomotor activity
(rocking,
pacing, or immobility). While some who experience an apparent
schizophrenic episode will recover fully, schizophrenia is a
chronic
or recurrent illness for most people.

In order to obtain the most appropriate treatment, accurate
diagnosis
by a qualified psychiatrist is essential since other psychotic
conditions--those induced by such drugs as LSD or PCP, or by
mania,
depression, or organic brain disturbances--may mimic symptoms of
schizophrenia.

Mood disorders. Depression, mania, and bipolar disorder
(bipolar
disorder is also called manic-depressive illness and is
characterized
by cycles of depression and mania) are referred to as mood
disorders.
Mood disorders affect an estimated 11.6 million adults in the
United
States, or 6.3 percent of the population, each year.

Depressive disorders change the way people think, feel,
and behave.
Unlike the normal "down" mood that we all experience at one time
or
another, major depression lingers on and becomes more
pronounced than
warranted by the events of daily living. Depression interferes
with
the ability to think, to concentrate, and to enjoy the normal
pleasures of life. Depressed people may brood about death and
dying,
and may exhibit suicidal behavior. Some people experience
depressive
episodes--onsets of symptoms that can be severe and disabling.
Others
can continue to function, but feel depressed and "under the
weather"
all the time, a condition called dysthymia.

Manic episodes, by contrast, are marked initially by
elation,
hyperactivity, irritability, decreased need for sleep, inflated
self-esteem, and increased loud speech, with abrupt changes of
topic.
As the episode progresses, the person with mania can, like those
with
schizophrenia, become overtly psychotic, experiencing delusions,
hallucinations, and bizarre behavior.

Individuals suffering from bipolar disorder alternate
between episodes
of excitement/mania and major depression. Symptoms can be severe
and
disabling, or relatively mild, a condition called
cyclothymia.

Anxiety disorders. Anxiety is a normal, necessary
part of life that
everyone experiences at times. As a symptom, it is not uncommon
in
the early stages of schizophrenia when the individual is
experiencing
strange new sensations; and it often accompanies mood disorders.
In
another group of disorders, however, anxiety is the core symptom.
Anxiety disorders affect approximately 10.1 percent of the
general
population, or more than 18 million people, during any year.
These
disorders can take several forms.

Generalized anxiety disorders are marked by jumpiness,
irritability,
tension, sweating, racing or pounding heart, and a variety of
other
symptoms associated with anxiety. The person is apprehensive, on
edge, and has problems getting to sleep. To be considered a
disorder,
the symptoms should be persistent, generally continuing for more
than
a few weeks.

People with panic disorder are subject to attacks of panic
from out of
nowhere, with no obvious cause. They become extremely frightened
and
often think they are going to die. They suffer heart
palpitations,
dizziness, chest pains, a sense of unreality, and other symptoms.
The
disorder can be limited to a period of a few weeks or months, but
more
commonly it recurs over time. Although the attack itself
generally
lasts only a few minutes, anticipating the feeling of
helplessness or
loss of control that accompanies the panic can make the person
reluctant to be alone or to leave home.

The individual whose frequent attacks have increasingly
constricted
normal activities is usually diagnosed as having
agoraphobia. This is
the most disabling of all the phobias, which are also considered
anxiety disorders. The person with agoraphobia usually avoids
situations where escape would be difficult or impossible--crowds,
tunnels, stores, bridges, elevators, or public transportation.
Some
people with agoraphobia become so fearful that they never leave
their
homes for years at a time.

Other types of phobia include simple phobias, the
persistent and
irrational fear of a specific object, activity, or situation, and
social phobias, the irrational fear of humiliating or
embarrassing
oneself in public.

Yet another anxiety disorder is posttraumatic stress
disorder, which
is an often recurrent reaction to a psychologically traumatic
event
that is outside the range of usual human experience. Wartime
combat,
bombing, rape, floods, or torture are examples of this type of
experience. Symptoms include reexperiencing the event,
nonresponsiveness to others, little interest in outside
activities,
sleeplessness, memory problems, and loss of concentration.

Obsessive-compulsive disorder (OCD) is an anxiety disorder
involving
repetitive thoughts and behaviors that are difficult if not
impossible
to control. The intrusive and obsessive thoughts may revolve
around a
fear of harming others or of being harmed. In response to
obsessive
thoughts, OCD victims often feel obligated to perform certain
rituals--behaving in a specific way a specific number of
times--to
ward off harm, even though they know that the behavior is
illogical.
Two of the most common OCD rituals are handwashing and checking.
For
example, persons who fear either being contaminated or
contaminating
others will wash their hands numerous times for long periods of
time
every day. Or persons who fear harming others, such as running
over
them with a car, will stop their car repeatedly to check on
whether
there is a victim lying dead on the road.

Some people with OCD are obsessed with self doubt and
compulsively
check to see if they have locked doors or turned off equipment or
carried out other tasks for which they feel responsible.

Personality disorders. The individual with a personality
disorder
demonstrates personality traits that are inflexible and cause him
or
her either to adjust poorly in social relationships or to suffer
internal distress. Characteristic of these disorders are rigid
and
deeply rooted dysfunctional patterns in relating, perceiving, and
thinking. Personality disorders typically become apparent in
adolescence or earlier and are often less obvious in middle and
old
age. This age-related pattern is especially true of the
individual
with an antisocial personality, usually a person in the
late teens or
the twenties who is in continuous social or legal trouble and
appears
to profit little from parental or social punishment.

The characteristics of borderline personality are
manifested in sudden
changes in mood, unstable interpersonal relationships, and
proneness
to unpredictable actions which could be self-damaging.
Individuals
with this disorder may also have a mood disorder.

An individual with paranoid personality characteristically
behaves
toward others with unwarranted suspicion, envy, jealousy, and
stubbornness. He is ready to believe that others have taken
advantage
of him, even when evidence to the contrary is presented.

MENTAL ILLNESSES CAN BE TREATED

Thanks to research, many effective therapies are available for
the
treatment of mental illnesses. Medications and different types
of
psychosocial therapies have been used alone or in combination.
The
treatment chosen for an individual depends on the diagnosis and
severity of the illness. For severe disorders, such as
schizophrenia,
depression, and bipolar disorder, as well as some anxiety
disorders, a
doctor usually prescribes medication and some form of
psychosocial
therapy. These include individual psychotherapy, group and
family
therapy, behavior therapy, marital counseling, recreational
therapy,
occupational therapy, hypnotherapy, behavior modification, art
therapy, and psychodrama. With some other disorders,
psychosocial
therapy may be all that is needed for a successful recovery.

At times, electroconvulsive therapy, often referred to as ECT or
"shock" therapy, can be life-saving for severely depressed and
suicidal individuals, some of whom may not respond to other
therapies.

THESE PEOPLE CAN HELP

Psychiatrists, psychiatric social workers, psychologists,
psychiatric
nurses, mental health counselors and aides, or teachers who are
specially trained in the area of mental illnesses and their
treatment
are among those who can be of assistance. It is beneficial to
discuss
problems with a family doctor or clergyman who can offer referral
information. Self-help organizations can also be beneficial.

HOW TO FIND HELP

There are many services available to persons experiencing mental
and
emotional problems:

Mental health associations, consumer organizations, and
mutual
help groups can provide assistance and information about
mental
health resources available in your community.

Professional associations usually have State or local
chapters
that can help in finding an appropriate professional in the
community. These include the State psychiatric and
psychological associations or medical societies.

Family service agencies may also provide information,
referrals,
and counseling for individuals and families.

State and local departments of social services, city or
county
health departments, or county medical associations and
others,
including Veterans' Administration hospitals, school
counseling
programs, and private clinics, can also provide help.

State mental hospitals usually maintain special units for
intensive short-term treatment and specialized programs for
disorders of longer duration. Some private hospitals also
have
short-term psychiatric, intensive-care units.

Community mental health centers provide a myriad of mental
health services including inpatient, outpatient, partial
hospitalization, and aftercare services. Also included are
services for children and the elderly.

To obtain the name and telephone number of mental health services
in
your community, scan the front cover of your telephone book where
police and fire departments list their telephone numbers. Often
mental health programs are listed on this page. You can check
the
Yellow Pages under "mental health," "health," "social services,"
"suicide prevention," "hospitals," or "physicians." For
appropriate
numbers, you can also call directory assistance or the operator
and
request the telephone number of your local mental health center.

Once you make contact with your local mental health clinic, you
will
meet trained personnel who can answer your questions, provide
assistance, or direct you to a further source of help.

If an emergency exists--someone is threatening suicide or acting
in a
violent or extremely bizarre manner--call the police or an
ambulance.
You can also contact a mental health hotline or suicide
prevention
center.

THREE IMPORTANT TIPS

How much you are helped depends on several factors: (1)
Obtaining the
right diagnosis is important; some mental illnesses have one or
more
symptoms in common, so careful evaluation is required; (2) Your
therapist should have the training and most up-to-date
information
needed to treat your mental illness; (3) There should be a "fit"
between your personality and that of the therapist. It pays to
seek
help from another if you feel dissatisfied or unaided by a
particular
therapist.

Most of us experience stress in the course of living. If you
have a
mental or emotional problem from time to time, try not to be
unduly
discouraged. But if the problem persists, or is severe, you
should
seek help. Remember, you are not alone.

For further information on mental health and mental
illness, write to:

* Definitions of mental illnesses in this section were derived
from the Diagnostic and Statistical Manual of Mental Disorders,
Third
Edition-Revised, American Psychiatric Association, 1987.

** Rates are based on estimates of the U.S. 1989
population--184,000,000 persons aged 18 and over. Source is
unpublished data from the Epidemiology and Psychopathology
Branch,
Division of Clinical Research, National Institute of Mental
Health.

MESSAGE FROM THE NATIONAL INSTITUTE OF MENTAL
HEALTH

Research conducted and supported by the National Institute of
Mental
Health brings hope to millions of people who suffer from mental
illness and to their families and friends. During the past 10
years,
researchers have advanced our understanding of the brain and
vastly
expanded the capability of mental health professionals to
diagnose,
treat, and prevent mental and brain disorders.

Now, in the 1990s, which the President and Congress have declared
"The
Decade of the Brain," we stand at the threshold of a new era in
brain
and behavioral sciences. Through research, we will learn even
more
about mental disorders such as depression, bipolar disorder,
schizophrenia, panic disorder, and obsessive-compulsive disorder.
And
we will be able to use this knowledge to develop new therapies
that
can help more people overcome mental illness.

The National Institute of Mental Health is part of the National
Institutes of Health (NIH), the Federal Government's primary
agency
for biomedical and behavioral research. NIH is a component of
the
U.S. Department of Health and Human Services.

All material appearing in this brochure is in the public domain
and
may be reproduced or copied without permission from the
Institute.
Citation of the source is appreciated.

Acknowledgments

This brochure was revised by Margaret Strock, staff member in the
Information Resources and Inquiries Branch, Office of Scientific
Information, National Institute of Mental Health (NIMH). Expert
assistance was provided by Frederick K. Goodwin, M.D.,
Administrator,
Alcohol, Drug, Abuse and Mental Health Administration; David
Shore,
M.D., and Harry Gwirtsman, M.D., and Lynn Cave, NIMH staff
members.
Their help in assuring the accuracy of this brochure is
gratefully
acknowledged.